This application addresses broad Challenge Area 15: Translational Science and specific Challenge Topic 15-RR-101: Applied Translational Technology Development. It is evident that prior to dialysis access failure (thrombosis), access flow decreases for every dialysis patient from a baseline value to zero over some time period. However, the natural history and variation of access failure is still poorly understood, as evidenced by mixed results when access flow monitoring is implemented clinically. What is known is that customary monthly access flow monitoring is not frequent enough in many clinical settings. Since the effectiveness of access surveillance depends on the frequency with which monitoring can be performed, an easy-to-use and accurate method of measuring access flow is needed to understand flow variation and to determine how to optimally monitor patients with differing characteristics. The new instrument being developed and tested in this project is based on mature Doppler technology mitigating development risk, yet will employ a novel measurement method, technologically advanced electronics and software to make a user-friendly, low-cost Doppler- based monitoring device tailored for dialysis access monitoring. This smart sensor will allow cost-effective, accurate flow monitoring during each dialysis treatment for every patient, which is essential to optimize combined sensitivity and specificity for this clinical application. The results of this proposal will 1) improve dialysis decision-making leading to a paradigm shift to optimize access monitoring and 2) provide a platform Doppler device for other vascular applications. Further, this project will actually reduce dialysis vascular access cost. Realistic estimates indicate $300 million in annual savings in the US alone, while stimulating jobs in the technical healthcare sector. PUBLIC HEALTH RELEVANCE: It is important to fund technologies that will make US workers more competitive in the global marketplace by reducing overall healthcare costs. This project achieves the scientific and economic objectives of the ARRA. This project will result in a low-cost compact Doppler based smart sensor for dialysis vascular access management. This device and technology will reduce dialysis healthcare cost and are easily generalizable to other vascular applications, offering a high-performance alternative to existing Doppler devices. The project supports rapid translation into the private sector and job creation achieving scientific and economic stimulus objectives of the ARRA.